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OArLLRE�,f/`�� ``J����r-.�� • eHo roc Hurae�c <br />WW`SAN JOAQUIN COUNTYPUBLIC HEALTH SERVICES <br />JAN 1 7 2003 ENVIRONMENTAL HEALTH DIVISION <br />304 EAST WESER <br />CKTON CA 9 THIRD FLOOR I' <br />5202 <br />ENVEONMEN1 HEALTH srocKTON -3 s0 <br />(zos) aha-3a2o <br />PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br />APPUCANT %Lll Alma Bu51NEss/AGENCY <br />ADDRESS LJc�lr C i�VPi^tX`Jt-r' U 1 i1SC. C` l—A "IC'1 r'�lJ ._ <br />PHONE SCS '" tiL`1 — ti't f FAC51MILE <br />i o1 g- 0 3 °lays <br />TENTATIVE* APPOINTMENT DATE TIME ' <br />(Please give 7 to 10 business days from date of application submittal) <br />rj <br />CHECK BOX TO EXPEDITE REQUEST • $78.00 FEE— REQUEST PROCESSED IN 3 BUSINESS DAYS �I J <br />-7 C-w� Cf -f <br />SIGNATURE OF APPLICANT _ DATE -.---- <br />ENVIRONMENTAL HEALTH DIVISION FILES <br />Ag::11NDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br />;MOTHER CLEANUP SITE (NON -LOP) ❑ FOOD FACILITY CI SOLID WASTE VEHICLE <br />;WUNDERGROUNDTANK (MONITORINOIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br />,;. HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br />❑ TIERED PERMITTED FACILITY ❑ MOTEUROTEL ❑ PUMPER TRUCK/YARDICHEM T OILETS <br />❑ TATTCOIBOOY PEIRCING ❑ POOUSPA ❑ LAND USE APPLICATION SITES <br />❑ MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM 0 OTHER (PLEASE SPECIFY ABOr'EI <br />type(s) of files from the list above by c:tecking <br />1. List up to ten addresses in the space above. MU57 be selected. Fax to (x09} 4fki D138 ar-m .ia the <br />the appropriate box(es). At least one file type <br />addrm Indlsated above. <br />2. EHD will notify the applicant if any EHD files exist, An appointment for review will be confirme i <br />approximately five business days but no later than ten (10) days after receipt of application. TI Ia files <br />will be hold for a maximum of five business days for review, Appointments should be schedul id <br />accordingly. <br />3. A file that is actively being worked on by EMD staff may not be immediately avallable for revieM .. A now <br />application may be submitted when the file is available. <br />4. Any file not returned In the same condition as released will be reorganized by EHD staff at the ixpense <br />of the applicant. Future file reviews by the same applicant may require a $78.00 deposit.prior t;t review. <br />5. 'TENTATIVE appointment dates must be confirmed with EHD staff. <br />6. Applications received after 8:00 pm will be processed the next business day. <br />CONFIRMED APPOINTMENT DATE TIME <br />DATE CONFIRMED PHONE FAX INITIALS .. <br />REVIEWED <br />CCN <br />